Abstract:
Adolescents living with HIV (ALHIV) who are pregnant, or parenting, are an important but
understudied group. This study explores the challenges in promoting the health of these
adolescents and preventing onward transmission. We used existing semi-structured interview data
from a 2014 study conducted among Kenyan ALHIV (ages 15–19), their family members, and
local health staff to examine adolescent HIV-testing, disclosure, and treatment engagement,
focusing on participants who were pregnant, had given birth, or had fathered a child. A total of 28
participant interviews were analyzed, including those conducted with nine ALHIV, four family
members, and 15 HIV providers. Four adolescent participants were not in care at the time of their
interview. Our analysis also included a transcript from a stakeholder meeting involving HIV
providers and associated administrators, held to disseminate and garner feedback on, preliminary
findings from the original study. Based on our analysis, adolescents frequently reported being
alone during testing, experiencing fear and denial on receiving their results, and delaying
disclosure to family and linkage to treatment. They also mentioned a lack of contraceptive
counseling, with some reporting multiple pregnancies. Providers voiced misgivings and
uncertainty about disclosing HIV diagnoses to minor adolescents without a family member present
and reported severe shortages of personnel and resources to adequately serve ALHIV in rural
clinics. These findings highlight gaps in services that limit adolescent engagement in HIV
treatment prior to sexual debut and conceiving a child, and in PMTCT during and after pregnancy.
Greater research attention is needed to address ALHIV reproductive health needs, improve linkage.